Healthcare Provider Details

I. General information

NPI: 1770648495
Provider Name (Legal Business Name): IRON COUNTY DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E RUSSELL ST
IRONTON MO
63650-1516
US

IV. Provider business mailing address

215 E RUSSELL ST
IRONTON MO
63650-1516
US

V. Phone/Fax

Practice location:
  • Phone: 573-546-7111
  • Fax: 573-546-7284
Mailing address:
  • Phone: 573-546-7111
  • Fax: 573-546-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2004022494
License Number StateMO

VIII. Authorized Official

Name: DR. JOHN PAUL LAWSON JR.
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 573-546-7111